Bladder cancer treatment

Anatomy of the male urinary system (left panel) and female urinary system (right panel); two-panel drawing showing the right and left kidneys, the ureters, the bladder filled with urine, and the ureth

Bladder cancer is a disease in which malignant (cancer) cells form in the tissues of the bladder.

The bladder is a hollow organ in the lower part of the abdomen. It is shaped like a small balloon and has a muscular wall that allows it to get larger or smaller. The bladder stores urine until it is passed out of the body. Urine is the liquid waste that is made by the kidneys when they clean the blood. The urine passes from the two kidneys into the bladder through two tubes called ureters. When the bladder is emptied during urination, the urine goes from the bladder to the outside of the body through another tube called the urethra .

Anatomy of the male urinary system (left panel) and female urinary system (right panel) showing the kidneys, ureters, bladder, and urethra. Urine is made in the renal tubules and collects in the renal pelvis of each kidney. The urine flows from the kidneys through the ureters to the bladder. The urine is stored in the bladder until it leaves the body through the urethra.

There are three types of bladder cancer that begin in cells in the lining of the bladder. These cancers are named for the type of cells that become malignant (cancerous):

    Transitional cell carcinoma. Cancer that begins in cells in the innermost tissue layer of the bladder. These cells are able to stretch when the bladder is full and shrink when it is emptied. Most bladder cancers begin in the transitional cells. Transitional cell carcinoma can be low-grade or high-grade:
      Low-grade transitional cell carcinoma often recurs (comes back) after treatment, but rarely spreads into the muscle layer of the bladder or to other parts of the body.

    High-grade transitional cell carcinoma often recurs (comes back) after treatment and often spreads into the muscle layer of the bladder, to other parts of the body, and to lymph nodes. Almost all deaths from bladder cancer are due to high-grade disease.

    Squamous cell carcinoma. Cancer that begins in squamous cells. which are thin, flat cells that may form in the bladder after long-term infection or irritation.

    Adenocarcinoma. Cancer that begins in glandular (secretory) cells that are found in the lining of the bladder. This is a very rare type of bladder cancer.

    Cancer that is in the lining of the bladder is called superficial bladder cancer. Cancer that has spread through the lining of the bladder and invades the muscle wall of the bladder or has spread to nearby organs and lymph nodes is called invasive bladder cancer.

    See the following PDQ summaries for more information:

    Smoking can affect the risk of bladder cancer.

    Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk to your doctor if you think you may be at risk for bladder cancer. Risk factors for bladder cancer include:

      Using tobacco. especially smoking cigarettes. Having a family history of bladder cancer. Having certain changes in the genes that are linked to bladder cancer. Being exposed to certain chemicals in the workplace. Past treatment with certain anticancer drugs. such as cyclophosphamide or ifosfamide. or radiation therapy to the pelvis . Taking Aristolochia fangchi. a Chinese herb . Drinking well water that has high levels of arsenic . Drinking water that has been treated with chlorine . Having a history of bladder infections, including bladder infections caused by Schistosoma haematobium . Using urinary catheters for a long time.

    Signs and symptoms of bladder cancer include blood in the urine and pain during urination.

    These and other signs and symptoms may be caused by bladder cancer or by other conditions. Check with your doctor if you have any of the following:

      Blood in the urine (slightly rusty to bright red in color). Frequent urination. Pain during urination. Lower back pain.

    Tests that examine the urine, vagina, or rectum are used to help detect (find) and diagnose bladder cancer.

    The following tests and procedures may be used:

      Physical exam and history . An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

    Internal exam . An exam of the vagina and/or rectum. The doctor inserts gloved fingers into the vagina and/or rectum to feel for lumps.

    Cystoscopy . A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope is inserted through the urethra into the bladder. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.

    Cystoscopy. A cystoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted through the urethra into the bladder. Fluid is used to fill the bladder. The doctor looks at an image of the inner wall of the bladder on a computer monitor.

    Intravenous pyelogram

    (IVP). A series of x-rays of the kidneys, ureters, and bladder to find out if cancer is present in these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.

    Biopsy . The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. A biopsy for bladder cancer is usually done during cystoscopy. It may be possible to remove the entire tumor during biopsy.

    Certain factors affect prognosis (chance of recovery) and treatment options.

    The prognosis (chance of recovery ) depends on the following:

      The stage of the cancer (whether it is superficial or invasive bladder cancer, and whether it has spread to other places in the body). Bladder cancer in the early stages can often be cured . The type of bladder cancer cells and how they look under a microscope. Whether there is carcinoma in situ in other parts of the bladder. The patient’s age and general health.

    If the cancer is superficial, prognosis also depends on the following:

      How many tumors there are. The size of the tumors. Whether the tumor has recurred (come back) after treatment.

    Treatment options depend on the stage of bladder cancer.

    Stages of Bladder Cancer

    After bladder cancer has been diagnosed, tests are done to find out if cancer cells have spread within the bladder or to other parts of the body.

    The process used to find out if cancer has spread within the bladder lining and muscle or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

      CT scan (CAT scan). A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. To stage bladder cancer. the CT scan may take pictures of the chest, abdomen. and pelvis .

    MRI (magnetic resonance imaging). A procedure that uses a magnet, radio waves. and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

    Chest x-ray . An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

    Bone scan . A procedure to check if there are rapidly dividing cells. such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.

    There are three ways that cancer spreads in the body.

      Tissue. The cancer spreads from where it began by growing into nearby areas. Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body. Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

    Cancer may spread from where it began to other parts of the body.

    When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor ) and travel through the lymph system or blood.

      Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body. Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

    The metastatic tumor is the same type of cancer as the primary tumor. For example, if bladder cancer spreads to the bone, the cancer cells in the bone are actually bladder cancer cells. The disease is metastatic bladder cancer, not bone cancer.

    Stage 0 bladder cancer; drawing shows the bladder, ureter, prostate, and urethra. First inset shows papillary carcinoma on the inner lining of the bladder. Second inset shows carcinoma in situ on the inner lining of the bladder. Also shown are the layers of connective tissue and muscle tissue of the bladder and the layer of fat around the bladder.

    The following stages are used for bladder cancer:

    Stage 0 (Papillary Carcinoma and Carcinoma in Situ)

    Stage 0 bladder cancer. Abnormal cells are found in the tissue lining the inside of the bladder. Stage 0a may look like tiny mushrooms growing from the lining of the bladder. Stage 0is is a flat tumor on the tissue lining the inside of the bladder.

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